Abstract Background: Behcet's disease (BD) is a systemic inflam-matory disease in which gender seems to have an influence on certain clinical findings, disease severity and outcome. Aim of Study: To evaluate the impact of gender difference on disease presentation and outcome on a cohort of Egyptian patients with BD. Patients and Methods: In this multi-center comparative study, 170 patients diagnosed according to the BD diagnostic criteria of the International Study Group in 1990 and following up in the Rheumatology Department, Faculty of Medicine of the Cairo University Hospital (116 patients), Fayoum Univer-sity Hospital (44 patients), and Beni Suef University Hospital (10 patients) were enrolled and grouped according to gender. Results: The patients' mean age was 35.8±8.5 years and the male to female ratio was 4.4:1. Vascular manifestations (p=0.014), especially arterial/venous thrombosis (p=0.004) and aneurysm formation (p=0.026) were detected to be statis-tically significantly higher in male compared to female BD patients. Female BD patients were found to have higher erythrocyte sedimentation rate (ESR) (p=0.006), lower hemo-globin and WBC count (p=0.001 and p=0.002 respectively). Cyclophosphamide and anticoagulation were significantly more frequently used by male BD patients (p=0.031 and p=0.045 respectively). No gender difference was observed regarding disease activity using BDCAF (p=0.158), whereas damage using vasculitis damage index (VDI) was significantly higher in male BD patients (p=0.038). Conclusion: Vascular manifestations, the use of cyclo-phosphamide and anticoagulation as well as vasculitis damage index were significantly more frequent in male BD patients which may implicate poor outcome.